Self‐care for coronavirus disease through electronic health technologies: A scoping review

Abstract Background and Aims Considering the rapid spread and transmission of COVID‐19 and its high mortality rate, self‐care practices are of special importance during this pandemic to prevent and control the spread of the virus. In this regard, electronic health systems can play a major role in improving self‐care practices related to coronavirus disease. This study aimed to review the electronic health technologies used in each of the constituent elements of the self‐care (self‐care maintenance, self‐care monitoring, and self‐care management) during the COVID‐19 pandemic. Methods This scoping review was conducted based on Arksey and O'Malley's framework. In this study, the specific keywords related to “electronic health,” “self‐care,” and “COVID‐19” were searched on PubMed, Web of Science, Scopus, and Google. Results Of the 47 articles reviewed, most articles (27 articles) were about self‐care monitoring and aimed to monitor the vital signs of patients. The results showed that the use of electronic health tools mainly focuses on training in the control and prevention of coronavirus disease during this pandemic, in the field of self‐care maintenance, and medication management, communication, and consultation with healthcare providers, in the field of self‐care management. Moreover, the most commonly used electronic health technologies were mobile web applications, smart vital signs monitoring devices, and social networks, respectively. Conclusion The study findings suggested that the use of electronic health technologies, such as mobile web applications and social networks, can effectively improve self‐care practices for coronavirus disease. In addition, such technologies can be applied by health policymakers and disease control and prevention centers to better manage the COVID‐19 pandemic.


| INTRODUCTION
Coronavirus, also known as severe acute respiratory syndrome (SARS-CoV-2), was first identified in Wuhan City, Hubei Province, China, in December 2019. 1 The outbreak of coronavirus was announced a pandemic by the World Health Organization (WHO) in March 2020. Despite serious global efforts to control and eradicate the virus, more than 267,865,289 laboratory approved cases and more than 5,285,888 deaths caused by this disease were recorded around the world until December 10, 2021. 2,3 The patients affected by coronavirus may exhibit no symptoms at all or some symptoms (mild to severe) within 2−14 days after exposure to the virus. In other words, any person is likely to be in exposure to asymptomatic patients. Considering the importance of coronavirus disease as a communicable infectious disease, providing self-care services to people to fight against this disease can be considered a major achievement. 4 As defined by WHO, self-care refers to the ability of individuals, families, and communities to promote health, prevent disease, maintain health, and cope with illness and disability with or without the support of a healthcare provider. 5 Self-care is also defined as one's ability to take care of oneself and perform practices necessary to achieve, maintain or promote optimal health (including specific practices to deal with acute and chronic health problems). 6 Based on another definition, self-care is a process in which one takes advantage of their knowledge, skills, and abilities as a resource for taking care of their health. 7 The three elements of this concept are self-care maintenance, self-care monitoring, and self-care management. 8 Self-care maintenance refers to those behaviors performed to improve well-being, preserve health, or maintain physical and emotional stability or behaviors that a patient with one or more chronic conditions performs to restore his/her health. Self-care maintenance behaviors may be related to your lifestyle (e.g., non-use of tobacco, having healthy foods and meals, and stress management) or medical advice (e.g., taking medicines as prescribed). Such behaviors may be also recommended by others (e.g., healthcare professionals or family members), or patients themselves decide to adopt them to achieve their health-related goals. 8 Self-care monitoring is the process in which you closely observe and follow any change in your vital signs and symptoms. For example, some people regularly control their weight to achieve weight gain and loss or some people regularly visit a dentist for dental examinations to prevent or treat tooth decay. Other examples of self-monitoring behaviors, which aim to achieve physical and emotional stability, are blood glucose checking by diabetic patients, daily weight checks by patients with heart failure, and emotional monitoring by patients with mental illnesses. 8 Self-care management involves the evaluation of physical and emotional changes and deciding if these changes need to be addressed. These changes may result from diseases, treatments, or the environment. 8 Electronic health is a solution based on information and communication technology (ICT) that has attracted the attention of many researchers as a strategy to realize self-care for the COVID-19 pandemic. [9][10][11] A variety of scientific definitions have been proposed for electronic health. 12 WHO defines electronic   health as the cost-effective and secure use of ICT in support of   health and health-related fields, including healthcare services,   health surveillance, health literature and health education, knowledge, and research. Electronic health seems to be able to benefit not only healthcare providers and health policymakers but also the general public, especially patients. 9 According to researchers, some of the function of electronic health technologies in line with the realization of self-care practices for coronavirus disease are as follows: access to evidence-based information raise patients' awareness of self-care, medication management, nutrition management, [9][10][11] registration of symptoms by patients receive feedback on their health status, 9,10 recall of medical appointments, stress management, identification of high-risk locations for COVID-19, the introduction of specialized centers providing services related to coronavirus disease, 10 measurement the patients' vital signs, such as blood oxygen, communication with healthcare providers, 9 and reduction of inperson visits to medical centers to reduce the risk of exposure to infected individuals.
Although electronic health is not a new concept in the health and medical literature, it is playing a more prominent and critical role during the COVID-19 pandemic because of the further need of communities for such technologies. 13 This scoping review aims to identify the electronic health technologies used in each of the constituent elements of the self-care (self-care maintenance, selfcare monitoring, and self-care management) during the COVID-19 pandemic.

| Identification of relevant studies
In this study, mesh terms, and keywords related to "self-care," "covid-19," "telemedicine," and "health informatics" were searched on PubMed, Web of Science, Scopus, and Google (Table 1)

| Selection of studies
The selection of articles included two steps: (1) title and abstract screening and (2) full-text articles check. The authors were trained by the senior author (F. A.) to ensure the accuracy and consistency of the selection process. Then the title and abstract screening was carefully reviewed and the authors received feedback from the project manager. Two authors (S. A. and F. R.) independently evaluated the articles based on the inclusion and exclusion criteria and categorized them as "include," "exclude," and "undecided." They discussed about the articles categorized as "undecided" with the senior author to take the final decision about them.
The inclusion criteria were as follows: (1) English articles and (2) articles and websites that emphasized the use of electronic health technologies regarding self-care for coronavirus disease. The exclusion criteria were also the articles that deal with the use of electronic health technologies regarding self-care of other diseases and 2-articles written in languages other than English.

| Charting the data
The data contained in the selected articles were extracted using a data extraction form, which consisted of some items, including: "publication year," "country," "article type" (Table 2), "concept(s) of self-care in each study," "relevant e-health solutions," and "strengths and limitations" - (Table 3). Finally, the extracted data were inserted into Excel to classify and report the results. In relation to Table 3, only the articles that mentioned their strengths and limitations were added to Table. 2.6 | Collating, summarizing, and reporting the results At this stage, the application of electronic health technologies in each of the self-care elements and types of the technologies used for each element were classified and reported in a table (Table 3). In addition, the geographical distribution of the studies was reported as a figure (Figure 1).

| Search results
A total of 1328 articles were selected from the above-mentioned databases. After eliminating duplicate articles and checking the title and abstract of the remaining articles, 52 articles were selected for further review and evaluation. When the full-text articles were reviewed, 10 articles were eliminated because of irrelevance to selfcare for coronavirus disease. After checking the references of T A B L E 1 Search strategy in PubMed database.

| Characteristics of the studies and interventions
Based on the findings, 29 (53%), 18

Characteristics Number of studies (n) Studies
Year of publication 2020:29 T A B L E 3 Self-care concepts and type of e-health tools. and also to find out the elements of self-care (self-care maintenance, Studies have also indicated that apps about mental health can help individuals reduce their symptoms of anxiety and depression and better manage their stress. 74,75 In terms of geographical distribution, most studies were conducted in Europe, Asia (especially East Asia), and North America.
This can be attributed to the development of ICT infrastructure and the adoption of appropriate electronic health strategies for the COVID-19 pandemic in these areas. 76,77 The study findings also indicated that the use of new There are a variety of smartphone apps that can be used to promote the acceptance and adoption of regular physical activity. 85

ACKNOWLEDGMENTS
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

CONFLICT OF INTEREST STATEMENT
The authors declare no conflict of interest.

DATA AVAILABILITY STATEMENT
All data generated or analyzed during this study are included in this published article. All authors have read and approved the final version of the manuscript had full access to all of the data in this study and takes complete responsibility for the integrity of the data and the accuracy of the data analysis. The abstracts for these studies are available in the Web of science, Pubmed, and Scopus database.

TRANSPARENCY STATEMENT
The lead author Sohrab Almasi affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.